Pharmacy Billing Specialist I

Alaska Native Tribal Health Consortium (ANTHC); Anchorage (AK); On-site; USD 55,000 - 75,000; Full time

Job summary

The Alaska Native Tribal Health Consortium seeks a Pharmacy Billing Specialist to process insurance claims for pharmacy services at ANMC and affiliated clinics in Alaska. Under close supervision, prepares and submits claims to third party payers and reviews records for accuracy.

This role requires a high school diploma or GED, pharmacy billing experience by level, and a current pharmacy technician license with PTCB certification on hire.

Qualifications

• High school diploma or GED required.
• Pharmacy billing experience varies by level (I: 6 months; II: 1 year; III/IV: 3–5 years).
• Current Pharmacy Technician License required; PTCB certification on hire for I–IV.

Responsibilities

• Prepare and submit insurance claims for pharmacy patients.
• Review electronic health records to verify billable charges.
• Respond to inquiries from patients, physicians, and insurers.
• Maintain filing, logs, and monthly reports.
• Assist in orientation and training; provide leadership as assigned.

Skills

Medical billing

Customer service

Office computer skills

Communication skills

Phone system navigation

Education

High school diploma or GED

Tools

Medical billing software

Job description

The Alaska Native Tribal Health Consortium is a non-profit Tribal health organization designed to meet the unique health needs of Alaska Native and American Indian people living in Alaska. In partnership with the more than 171,000 Alaska Native and American Indian people that we serve and the Tribal health organizations of the Alaska Tribal Health System, ANTHC provides world-class health services, which include comprehensive medical services at the Alaska Native Medical Center, wellness programs, disease research and prevention, rural provider training and rural water and sanitation systems construction.

ANTHC is the largest, most comprehensive Tribal health organization in the United States, and Alaska’s second-largest health employer with more than 3,100 employees offering an array of health services to people around the nation’s largest state.

Our vision: Alaska Native people are the healthiest people in the world.

ANTHC offers a competitive and comprehensive Benefits Package for all Benefit Eligible Employees, which includes:

• Medical Insurance provided through the Federal Employee Health Benefits Program as a Tribal Employee, with over 20 plans and tiers.
• Cost-Share Dental and Vision Insurances
• Discounted Pet Insurance
• Retirement Contributions with Pre-Tax or Roth options into a 403(b).
• 401(a) ANTHC Retirement Plan: After one year of employment, ANTHC will begin making matching contributions of up to 5% of your eligible pay, based on your own contributions. In addition, you may be eligible for an annual discretionary contribution of up to 3% from the employer.
• Paid Time Off starts immediately, earning up to 6 hours per pay period, with paid time off accruals increasing based on years of service.
• Eleven Paid Holidays
• Paid Parental Leave or miscarriage/stillbirth eligibility after six months of employment
• Basic Short/Long Term Disability premiums, Accidental Death and Dismemberment (AD&D) Insurance, and Basic Life Insurance are covered 100% by ANTHC, with additional options for Short-Term Disability Buy-Up Coverage and Voluntary Life for yourself and your family members.
• Flexible Spending Accounts for Healthcare and Dependent Care.
• Ancillary Cash Benefits for accident, hospital indemnity, and critical illness.
• On-Site Child Care Facility with expert-designed classrooms for early child development and preschool.
• Employee Assistance Program with support for grief, financial counseling, mental/emotional health, and discounted legal advice.
• Tuition Discounts for you and your eligible dependents at Alaska Pacific University.
• On-Site Training Courses and Professional Development Opportunities.
• License and certification reimbursements and occupational insurance for medical staff.
• Emergency Travel Assistance
• Education Assistance or Education leave eligibility
• Discount program for travel, gym memberships, amusement parks, and more.

Visit us online at www.anthc.org or contact Recruitment directly at [e-mail].

Alaska Native Tribal Health Consortium has a hiring preference for qualified Alaska Native and American Indian applicants pursuant to P.L. 93-638 Indian Self Determination Act.

Summary

Under close supervision, prepares and submits insurance claims; reviews and adjusts accounts to ensure accurate and thorough billing of claims at the Alaska Native Tribal Health Consortium (ANTHC) and the Alaska Native Medical Center.

Responsibilities

All

Prepares and submits insurance claims to all third party payers for all patients who receive Pharmacy care from both ANTHC and SCF providers.

Reviews electronic health record to determine billable charges. Reviews all claims before submission to insurance companies. Maintains file system for billed claim records and back up for audit purposes. Verifies coverage and follows up on submitted claims. Requests corrected diagnosis for reimbursement purposes from physicians and mid-levels.

Responds to inquiries from patients, physicians, and insurance companies regarding covered charges, remittance advices, and billing questions. Screens calls and visitors to determine the nature of the visit or phone call and the urgency of the contact to ensure a timely, efficient, and appropriate response.

Works with Medicaid, Medicare, and secondary insurance companies for submission of claims, to verify coverage, determine the status of claims, and resolve issues with the claims. Answers incoming phone calls and reviews incoming correspondence and materials.

Maintains a variety of files, logs, and registers. Prepares or assists in the preparation of monthly reports. Reviews insurance information in the computer registration to determine accuracy. Ensures that equipment is functional and there is an adequate supply of all necessary forms stocked. Facilitates and follows up on repair orders for maintenance.

Performs other duties as assigned.

Pharmacy Billing Specialist II

Performs complex and responsible tasks within this position and generally work with minimum supervision and follow-up from their supervisor.

Pharmacy Billing Specialist III

Performs high-level, complex and responsible tasks within this position and generally work with minimum supervision and follow-up from their supervisor.

Pharmacy Billing Specialist IV

Works with management in the maintenance, upkeep and distribution of billing policies, procedures, guidelines and standards. Works with insurance companies to optimize reimbursement by completing applications and understanding reimbursement policies of each third party.

Assists in the orientation of new clerical staff teaching those computer processes involved in collecting accurate information to ensure timely reimbursement. As requested, participates in general or special assignments.

Provides leadership, direction, and guidance to staff. Develops goals and priorities in conjunction with manager and employees, and assigns tasks and projects. Develops staff skills and training plans and oversees training and competency.

Other Information

Performs other duties as assigned or required.

KNOWLEDGE And SKILLS

All

Knowledge of medical billing and accounting procedures and applications.

Knowledge of commercial insurance and government reimbursement programs.

Knowledge of basic medical terminology and clinic systems.

Knowledge of reception, typing, computer operations, and filing procedures.

Knowledge of customer service concepts and practices.

Skill in operating a personal computer utilizing a variety of software applications, including medical billing programs.

Skill in tracking multiple projects.

Skill in establishing and maintaining cooperative working relationships with other employees.

Skill in conducting successful telephone consultations and operating a complex phone system.

MINIMUM EDUCATION QUALIFICATION

All

A high school diploma or GED equivalent.

Minimum Experience Qualification

Pharmacy Billing Specialist I

Non-supervisory – Six (6) months of pharmacy technician and billing experience. An equivalent combination of relevant education and/or training may be substituted for experience.

Pharmacy Billing Specialist II

Non-supervisory - One (1) year of pharmacy technician and billing experience. An equivalent combination of relevant education and/or training may be substituted for experience.

Pharmacy Billing Specialist III

Non-supervisory – Three (3) years of professional experience at Alaska Native Medical Center (ANMC) Pharmacy or related experience.

Pharmacy Billing Specialist IV

Non-supervisory – Five (5) years of professional experience at Alaska Native Medical Center (ANMC) Pharmacy or related experience.

MINIMUM CERTIFICATION QUALIFICATION

All

Current Pharmacy Technician License required.

Pharmacy Billing Specialist I

Must obtain Pharmacy Technician Certification Board (PTCB) certification within one year of employment. With prior approval from the Pharmacy Manager, PTCB certification may be extended beyond 1 year of employment if actively enrolled in a Pharmacy Technician Apprenticeship Program or pharmacy technician training course.

Pharmacy Billing Specialist II, III, and IV

Pharmacy Technician Certification Board (PTCB) Certification – Required on hire.